My son is experiencing condylar resorption (Diagnosis M26.623). His condyle is disintegrating and likely eventually closing his airway. We are seeing a dentist who believes that Advanced Lightwire Functional (ALF) appliance will help to correct the deformities that caused the condylar resorption and open his airway. I have the following dental codes. Would someone be able to give me the medical codes so that we could try to get medical insurance to cover some of the costs? I was able to get some codes but cannot locate codes for these:

D0140 Detailed and extensive oral exam
D0290 anterior-posterior skull film
D0350 oral and facial photographs
D0470 diagnostic casts

Thanks so much for any help!

Jill

Hi Jill!


D0140 - limited oral evaluation - problem focused
can be crosscoded to:
99202 - level 2 new patient Evaluation & Management (office visit)
or
99212 - level 2 established patient Evaluation & Management (office visit)


D0290 - this is actually not a valid code. Did you perhaps mean one of the following below?

D0220 - intraoral - periapical first radiographic image
D0230 - intraoral - periapical each additional radiographic image
D0240 - intraoral - occlusal radiographic image
D0250 - extra-oral – 2D projection radiographic image created using a stationary radiation source, and detector
D0270 - bitewing - single radiographic image


D0350 - 2D oral/facial photographic image obtained intra-orally or extra-orally
D0470 - diagnostic casts
can be crosscoded to:
99070 - special supplies & materials


Hope this helps!

Hi. I'm trying to submit this to my Dental Insurance, so I'm looking for the CDT code (not the medical codes), since they pay it at 100%. All I have is a diagnostic Code from the lab:
D10.39

I'm looking for the code for doing the pathology on the biopsy. Since these are 2 separate claims. The biopsy was conducted (and filed) by the oral surgeon, but the pathology is from an independent lab. The OS submitted their claim, but I have to submit the Lab claim myself.

I saw there were some pathology lab codes on my dental insurance's website.

perhaps it is D0473 Accession of tissue, gross and microscopic examination, preparation and transmission of written report

The lab billing department told me their procedure code was: 88342
I'm not sure if that is internal to their lab or an actual billing code.

-AC

Edited by user Tuesday, July 13, 2021 1:17:03 PM(UTC)  | Reason: name

Thanks. I used:
D0473 - accession of tissue, gross and microscopic examination, preparation and transmission of written report

I hope I don't have to file again. If I do, I would probably go with D0502, but hopefully this will do.

I really appreciate your help. Patient's shouldn't be made to file their own claims w/procedure codes--this should be the responsibility of the treating doctor/dentist/etc.

-AC

Hi Guest!

D6057 - custom fabricated abutment – includes placement
D6059 - abutment supported porcelain fused to metal crown (high noble metal)

For both of these services listed above, there is actually not direct crosscodes we are aware of, so if the medical insurers cannot accept the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Since it is a trauma case, you will want to be sure the ICD-10 (diagnosis) codes reflect that! If you can provide me some details about the accident (how it happened and what damage it caused), i am happy to offer you some coding options.


Hope this helps!

Hi Guest!

Absolutely!

D6010 - surgical placement of implant body: endosteal implant
can be cross coded to:
21248 - Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial(3 or less)


D6104 - bone graft at time of implant placement
can be crosscoded to:
21210 - graft, bone; nasal, maxillary, or malar areas
21215 - graft, mandibular
**use modifier -52 for reduced services when bone is not obtained from patient


D7921 – collection and application of autologous blood concentrate product
can be crosscoded to:
0232T - Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed


D2999 - unspecified restorative procedure, by report
D6057 - custom fabricated abutment – includes placement
D7210 - Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated
D7950 - osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report

The codes listed above do not have a direct crosscode we are aware of, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
**special note - since D2999 stands for an "unspecified" restorative procedure, you will likely need to ask your provider for a short description of what service/procedure this code is being used to represent


As far as the diagnosis code(s) - based on what you described, here are some coding options (you may need to consult with your provider to select the most appropriate loss of teeth and fracture codes):

For the trauma to your teeth:
One of these:
K08.411 - Partial loss of teeth due to trauma, class I
K08.412 - Partial loss of teeth due to trauma, class II
K08.413 - Partial loss of teeth due to trauma, class III
K08.414 - Partial loss of teeth due to trauma, class IV
K08.419 - Partial loss of teeth due to trauma, unspecified class

One or both of these:
S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture
S02.5XXB - Fracture of tooth (traumatic), initial encounter for open fracture

And this one if applicable:
G89.11 - Acute pain due to trauma

To describe the accident, both of these:
W01.198A - Fall on same level from slipping, tripping and stumbling with subsequent striking against other object, initial encounter
W17.4XXA - Fall from dock, initial encounter


Hope this helps!

Hi Guest!

I have listed the codes below in this message that are listed in Aetna’s medical policy for botox (the most common ones used for dental practices are J0585 and 64615) and a link to the Aetna medical policy on Botox:
http://www.aetna.com/cpb/medical/data/100_199/0113.html

Botox Type A:

HCPCS codes:
• J0585 - Botulinum toxin type A, per unit [Botox]
• J0586 - Injection, Abobotulinumtoxina, 5 units [Dysport]
• J0588 - Injection, incobotulinumtoxinA, 1 unit [Xeomin]

CPT Codes:
• 64611 - Chemodenervation of parotid and submandibular salivary glands, bilateral
• 64612 - Chemodenervation of muscles(s); muscles(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)
• 64615 - Chemodenervation of muscles(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)
• 64616 - Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)
• 64617 - larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed
• 64653 - Chemodenervation other area(s) (e.g., scalp, face, neck), per day
• 95873 - Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
• 95874 - Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

Botox Type B:

HCPCS Code:
• J0587 - Botulinum toxin type B, per 100 units

CPT Codes:
• 64616 - Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)
• 95873 - Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)
• 95874 - Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)


Hope this helps!